Kidney Week

Abstract: FR-PO220

What Characterizes the Patients Who Develop Repeated or Persistent Hyperkalemia? A Population-Based Laboratory Study of Potassium Trajectories in Patients with CKD

Session Information

• CKD: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Thomsen, Reimar W., Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark

Reimar W. Thomsen,

• Nicolaisen, Sia Kromann, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark

Sia Kromann Nicolaisen,

• Palaka, Eirini, AstraZeneca, Cambridge, United Kingdom

Eirini Palaka,

• Hasvold, Pål, AstraZeneca Nordic, Etterstad, Oslo, Norway

Pål Hasvold,

• Pedersen, Lars, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark

Lars Pedersen,

• Adelborg, Kasper, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark

Kasper Adelborg,

• Sorensen, Henrik Toft, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark

Henrik Toft Sorensen,

Background

Hyperkalemia (HK) (defined as blood potassium (K⁺) >5.0 mmol/L) is common among patients with chronic kidney disease (CKD) and associated with adverse outcomes. Little is known about the characteristics of patients with repeated and persistent HK.

Methods

Observational laboratory study of all patients with CKD in Northern Denmark, 2000-2012. For all CKD patients with an incident HK event, we examined K⁺ trajectories over 6 months. We described patient characteristics associated with persistent HK (2 or more elevated K⁺ tests >5.0 mmol/L with ≤1 normal K⁺ test in between) and repeated HK (2 or more elevated K⁺ tests separated by ≥2 normal K⁺ tests).

Results

In 157,283 patients with CKD (median age 73 years, 59% females, median number of annual K+ tests =4), 28% (n=43,845) had a subsequent HK event detected. Within 6 months after the first HK, 29% had died, 45% had no additional high K+ value, while 26% (n=11,390) fell into persistent or repeated HK pattern. FIGURE shows K+ trajectories for patients with persistent (A:2 high K+ tests, n=3,936; B:3 high tests, n= 1,236; C:≥4 high tests, n=974) or repeated HK (D, n=5,244). Important baseline predictors for persistent or repeated HK include low eGFR (prevalence ratio (PR)=2.40 (95% CI 1.91-3.01) for eGFR <15), severity of first HK event (PR=3.98 (95% CI 3.05-5.18) for K+ 6.0-6.5 mmol/L), and use of ACE-inhibitors (PR=1.32 (95% CI 1.23-1.41)) or spironolactone (PR=1.59 (95% CI 1.43-1.78)).

Conclusion

Repeated HK and persistently elevated K+ levels are common in CKD patients. The use of readily identifiable clinical predictors can help identify patients at highest risk, who can benefit most from effective K+ management.

FIGURE. Median K+ before and after a first HK event in 11,390 CKD patients with persistent or repeated HK trajectories over 6 months

Funding

• Commercial Support –